Does brief telephone support improve engagement with a web-based weight management intervention? Randomized controlled trial.
Does brief telephone support improve engagement with a web-based weight management intervention? Randomized controlled trial.
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DOI：
10.2196/jmir.3199
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发表时间：
2014-03-28
影响因子：
7.4
通讯作者：
Yardley L
中科院分区：
文献类型：
--
作者：
Dennison L;Morrison L;Lloyd S;Phillips D;Stuart B;Williams S;Bradbury K;Roderick P;Murray E;Michie S;Little P;Yardley L
最近的评论表明，基于网络的干预措施是有前途的方法，体重管理，但他们确定的困难与次优的使用。文献表明，为网站用户提供一定程度的人力支持可能会提高使用率和结果。我们在社区环境中传播了POWeR（“积极在线减肥”）基于网络的体重管理干预措施。POWeR包括每周一次的在线会议，强调自我监控，目标设定和认知/行为策略。我们的主要结果是干预的使用，我们调查了这是否是加强了简短的电话辅导。我们还探讨了短期自我报告体重减轻的组间差异。参与者是通过一系列方法招募的，包括有针对性的邮件、当地媒体上的广告、组织网站上的通知和社交媒体。共有786名成年人通过在线程序在个体水平上随机分为（1）POWeR（n=264），（2）POWeR+指导（n=247）或（3）等待列表对照组（n=275）。在随机化后约7天和28天联系POWeR+指导组的受试者，进行简短的指导电话，旨在促进继续使用网站。网站使用情况自动跟踪。通过在线自我报告评估体重。在分配到两个干预组的511名参与者中，完成POWeR课程的中位数仅为1次（仅POWeR的IQR 0-2，POWeR+教练的IQR 0-3）。尽管如此，还是有相当多的少数人至少完成了POWeR的三届核心会议：47名受访者患（17.8%，47/264），仅POWeR组和64名参与者（25.9%，（第64/247号决议）POWeR+教练组的参与者坚持干预的时间更长，完成核心三个阶段的可能性高出1.61倍与单纯POWeR组比较，差异有统计学意义（χ2 1=4.93; OR 1.61，95% CI 1.06-2.47; n=511）。意向治疗分析显示组间在体重减轻方面存在差异（F 2，782 =12.421，P<0.001）。两个干预组都报告了比等待名单对照组更多的体重减轻。POWeR加教练组的体重减轻幅度略大，但不显著。很大一部分被分配到POWeR加辅导的参与者拒绝电话或无法联系（57.9%，143/247）。探索性分析确定了健康和社会人口学差异，那些谁没有从事教练时，它提供给他们。参与指导的用户比那些没有参与的用户更多地使用干预措施，并且减轻了更多的体重。与大多数基于网络的干预研究一样，POWeR的使用总体上不理想。然而，我们的研究结果表明，补充基于网络的体重管理与简短的人力支持可以改善使用和结果，在那些谁采取了它。国际标准随机对照试验编号（ISRCTN）：98176068; http://www.controlled-trials.com/ISRCTN98176068（由WebCite存档，网址为http：//www.webcitation.org/6OKRjM2oy）。
Recent reviews suggest Web-based interventions are promising approaches for weight management but they identify difficulties with suboptimal usage. The literature suggests that offering some degree of human support to website users may boost usage and outcomes. We disseminated the POWeR (“Positive Online Weight Reduction”) Web-based weight management intervention in a community setting. POWeR consisted of weekly online sessions that emphasized self-monitoring, goal-setting, and cognitive/behavioral strategies. Our primary outcome was intervention usage and we investigated whether this was enhanced by the addition of brief telephone coaching. We also explored group differences in short-term self-reported weight loss. Participants were recruited using a range of methods including targeted mailouts, advertisements in the local press, notices on organizational websites, and social media. A total of 786 adults were randomized at an individual level through an online procedure to (1) POWeR only (n=264), (2) POWeR plus coaching (n=247), or (3) a waiting list control group (n=275). Those in the POWeR plus coaching arm were contacted at approximately 7 and 28 days after randomization for short coaching telephone calls aimed at promoting continued usage of the website. Website usage was tracked automatically. Weight was assessed by online self-report. Of the 511 participants allocated to the two intervention groups, the median number of POWeR sessions completed was just one (IQR 0-2 for POWeR only, IQR 0-3 for POWeR plus coach). Nonetheless, a substantial minority completed at least the core three sessions of POWeR: 47 participants (17.8%, 47/264) in the POWeR-only arm and 64 participants (25.9%, 64/247) in the POWeR plus coaching arm. Participants in the POWeR plus coaching group persisted with the intervention for longer and were 1.61 times more likely to complete the core three sessions than the POWeR-only group (χ2 1=4.93; OR 1.61, 95% CI 1.06-2.47; n=511). An intention-to-treat analysis showed between-group differences in weight loss (F 2,782=12.421, P<.001). Both intervention groups reported more weight loss than the waiting list control group. Weight loss was slightly, but not significantly, greater in the POWeR plus coaching group. A large proportion of participants assigned to POWeR plus coaching refused phone calls or were not contactable (57.9%, 143/247). Exploratory analyses identified health and sociodemographic differences between those who did and did not engage in coaching when it was made available to them. Users who engaged with coaching used the intervention more and lost more weight than those who did not. In common with most Web-based intervention studies, usage of POWeR was suboptimal overall. However, our findings suggest that supplementing Web-based weight management with brief human support could improve usage and outcomes in those who take it up. International Standard Randomized Controlled Trial Number (ISRCTN): 98176068; http://www.controlled-trials.com/ISRCTN98176068 (Archived by WebCite at http://www.webcitation.org/6OKRjM2oy).
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